Telephone Problem-Solving Treatment Improves Sleep Quality in Service Members With Combat-Related Mild Traumatic Brain Injury: Results From a Randomized Clinical Trial

J Head Trauma Rehabil. 2016 Mar-Apr;31(2):147-57. doi: 10.1097/HTR.0000000000000221.


Objective: Evaluate sleep quality, its correlates, and the effect of telephone-based problem-solving treatment (PST) in active duty postdeployment service members with mild traumatic brain injury (mTBI) SETTING:: Randomized clinical trial.

Participants: Active duty service members with combat-related mTBI.

Study design: Education-only (EO) and PST groups (N = 178 each) received printed study materials and 12 educational brochures. The PST group additionally received up to 12 PST telephone calls addressing participant-selected issues. Outcomes were evaluated postintervention (6 months) and at 12 months.

Main measure: Pittsburgh Sleep Quality Index.

Results: Sleep quality was manifestly poor in both groups at baseline (Pittsburgh Sleep Quality Index = 12.5 ± 4). Overall sleep quality was significantly different between the PST and EO groups at 6 months (P = .003) but not at 12 months. Longitudinally, PST significantly improved sleep quality at 6 months (P = .001) but not over the follow-up. Low sleep quality was associated with concussion symptoms, pain, depression, and posttraumatic stress disorder at all time points (P < .0001).

Conclusions: Sleep disorders, common in postdeployment service members with mTBI, are strongly associated with the presence of pain, posttraumatic stress disorder, and depression. Telephone-based PST may be an effective therapeutic approach for reducing sleep disorders in this population. Research should focus on maintenance of treatment gains.

Publication types

  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Brain Concussion / complications
  • Brain Concussion / psychology*
  • Brain Concussion / rehabilitation*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Military Personnel*
  • Problem Solving*
  • Sleep Wake Disorders / etiology
  • Sleep Wake Disorders / therapy*
  • Stress Disorders, Post-Traumatic / etiology
  • Stress Disorders, Post-Traumatic / therapy
  • Telemedicine*
  • Telephone
  • Young Adult